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Rahhal A, Provan D, Ghanima W, González-López TJ, Shunnar K, Najim M, Ahmed AO, Rozi W, Arabi A, Yassin M. A practical guide to the management of immune thrombocytopenia co-existing with acute coronary syndrome. Front Med (Lausanne) 2024; 11:1348941. [PMID: 38665297 PMCID: PMC11043582 DOI: 10.3389/fmed.2024.1348941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Immune thrombocytopenia (ITP) management with co-existing acute coronary syndrome (ACS) remains challenging as it requires a clinically relevant balance between the risk and outcomes of thrombosis and the risk of bleeding. However, the literature evaluating the treatment approaches in this high-risk population is scarce. Methods and Results In this review, we aimed to summarize the available literature on the safety of ITP first- and second-line therapies to provide a practical guide on the management of ITP co-existing with ACS. We recommend holding antithrombotic therapy, including antiplatelet agents and anticoagulation, in severe thrombocytopenia with a platelet count < 30 × 109/L and using a single antiplatelet agent when the platelet count falls between 30 and 50 × 109/L. We provide a stepwise approach according to platelet count and response to initial therapy, starting with corticosteroids, with or without intravenous immunoglobulin (IVIG) with a dose limit of 35 g, followed by thrombopoietin receptor agonists (TPO-RAs) to a target platelet count of 200 × 109/L and then rituximab. Conclusion Our review may serve as a practical guide for clinicians in the management of ITP co-existing with ACS.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Drew Provan
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Waleed Ghanima
- Østfold Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Khaled Shunnar
- Cardiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health—Unity Hospital, New York, NY, United States
| | - Ashraf Omer Ahmed
- Internal Medicine Department, Yale New Haven Health, Bridgeport, CT, United States
| | - Waail Rozi
- Internal Medicine Department, Rochester Regional Health—Unity Hospital, New York, NY, United States
| | | | - Mohamed Yassin
- Hematology Department, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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2
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Eid MM, Mostafa MR, Alabdouh A, Najim M, Mohamed S, Ziada AR, Takla A, Balmer-Swain M, Baibhav B, Al-Azizi KM, Goldsweig AM. Short duration of dual antiplatelet therapy following complex percutaneous coronary intervention: A systematic review and meta-analysis. Cardiovasc Revasc Med 2024; 61:8-15. [PMID: 37951758 DOI: 10.1016/j.carrev.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION AND AIM The optimal composition and duration of antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We conducted a meta-analysis to compare 1-3 months of dual antiplatelet therapy (DAPT) followed by monotherapy vs. 12 months of DAPT. METHOD MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing 1-3 months of DAPT followed by monotherapy vs. 12 months of DAPT in the outcomes of complex PCI from inception through January 2023. Outcomes of interest included major bleeding, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, target vessel revascularization, and stroke. RESULTS Compared to 12 months, 1-3 months of dual antiplatelet therapy had a weak association with less major bleeding (OR 0.67; 95 % CI, 0.44-1.00; p = 0.05; I2 = 28 %). There were no significant differences between the shorter and longer antiplatelet therapy in terms of all-cause mortality (OR 0.83; 95 % CI, 0.59-1.16; p = 0.21; I2 = 17 %), cardiovascular mortality (OR 0.87; 95 % CI, 0.53-0.42; p = 0.50; I2 = 0), MI (OR 0.97; 95 % CI, 0.69-1.35; p = 0.82; I2 = 32 %), stent thrombosis (OR 1.17, 95 % CI, 0.77-1.76; p = 0.38; I2 = 0 %), target vessel revascularization (OR 1.05, 95 % CI, 0.58-1.89; p = 0.82; I2 = 64 %), or stroke (OR 1.10, 95 % CI, 0.55-2.17; p = 0.37; I2 = 7 %);. CONCLUSION Among patients undergoing complex PCI, DAPT for 1-3 months may be associated with less major bleeding but similar rates of cardiovascular events (death, MI, stroke, stent thrombosis, and revascularization) compared to DAPT for 12 months.
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Affiliation(s)
| | | | - Ahmad Alabdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mostafa Najim
- Rochester Regional Health/Unity Hospital, Rochester, NY, USA
| | | | | | - Andrew Takla
- Rochester Regional Health/Unity Hospital, Rochester, NY, USA
| | | | | | - Karim M Al-Azizi
- Interventional Cardiology and Structural Heart Disease, Baylor Scott & White Health-The Heart Hospital Plano, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Eid F, Najim M, Elbanna M, Reda Mostafa M, Magdi M. Cardiac Arrest Following Retrieval of Inferior Vena Cava Filter: A Case Report and Literature Review of Pericardial Effusion and Cardiac Tamponade. Eur J Case Rep Intern Med 2023; 11:004192. [PMID: 38223284 PMCID: PMC10783465 DOI: 10.12890/2023_004192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
This report presents the clinical details and management of a 58-year-old Caucasian male with pericardial effusion and cardiac tamponade following outpatient inferior vena cava (IVC) filter removal. The patient was unresponsive and experienced cardiac arrest minutes after the procedure, requiring cardiopulmonary resuscitation. After return of spontaneous circulation he displayed somnolence, confusion and chest discomfort. Investigations revealed a large pericardial effusion, and an echocardiography confirmed cardiac tamponade. Prompt intervention involved pericardiocentesis, resulting in haemodynamic stabilisation and reduction in effusion size. The patient responded favourably with treatment. Differential diagnoses were considered and treatment options were discussed, highlighting the importance of timely recognition and appropriate intervention in managing pericardial effusion and cardiac tamponade. This report adds to the limited literature on pericardial effusion and cardiac tamponade following a scheduled outpatient IVC filter removal, emphasising the unique clinical presentation and successful management of this rare phenomenon. LEARNING POINTS Understanding the link between pericardial effusion and cardiac tamponade following IVC filter removal.Recognising and differentiating cardiac tamponade from other emergencies using clinical and diagnostic tools.Learning the immediate management of cardiac tamponade, emphasising the role of pericardiocentesis.
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Affiliation(s)
- Fahad Eid
- Rochester Regional Health/Unity Hospital, Rochester, USA
| | - Mostafa Najim
- Rochester Regional Health/Unity Hospital, Rochester, USA
| | | | | | - Mohamed Magdi
- Rochester Regional Health/Rochester General Hospital, Rochester, USA
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4
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Najim M, Reda Mostafa M, Eid MM, Alabdouh A, Awad AK, Elbanna M, Mohamed S, Alweis R, Al-Azizi KM, Mamas MA. Efficacy and safety of the new generation Watchman FLX device compared to the Watchman 2.5: a systematic review and meta-analysis. Am J Cardiovasc Dis 2023; 13:291-299. [PMID: 38026111 PMCID: PMC10658049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The first-generation Watchman 2.5 (W 2.5)TM presented several limitations, such as challenges in implantation within complex left atrial appendage (LAA) anatomies, higher incidence of peri-device leak, device recapture, and device-related thrombus (DRT). The newer generation Watchman FLX (W-FLX)TM was introduced with a modified design aiming to overcome these limitations. The purpose of this meta-analysis is to conduct a comparative assessment of the safety and efficacy of the W-FLX and 2.5 devices in clinical practice. METHOD The meta-analysis was conducted according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). Studies were located through a search strategy utilizing PubMed, Cochrane, Google scholar and MEDLINE from inception to March 2023, with a primary objective to compare the safety and efficacy of the W-FLX and W 2.5 devices. After applying the selection criteria, five studies were included in this analysis. RESULTS The analysis included five studies comprising 54,727 patients. The W-FLX is associated with an increase in procedural success (OR 7.49 [95% CI 1.98-28.26, P = 0.02; I2 = 0%]), and a significant reduction in mortality (OR 0.52 [95% CI 0.51-0.54, P<0.01; I2 = 0%], major bleeding 0.57 [95% CI 0.51-0.64, P<0.01; I2 = 0%]), device embolism (OR 0.35 [95% CI 0.18-0.70, P = 0.02; I2 = 0%]), and pericardial effusion (OR 0.33 [95% CI 0.26-0.41, P<0.01; I2 = 0%]). The rates of DRT and stroke were similar between the two groups. CONCLUSION Compared to the W 2.5, the W-FLX was associated with a higher procedural success rate and significantly reduced adverse outcomes including mortality, major bleeding, device embolization, and pericardial effusion.
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Affiliation(s)
- Mostafa Najim
- Rochester Regional Health/Unity HospitalRochester, NY, USA
| | | | | | - Ahmad Alabdouh
- Department of Medicine, University of KentuckyLexington, KY, USA
| | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams UniversityCairo, Egypt
| | | | | | - Richard Alweis
- Rochester Regional Health/Unity HospitalRochester, NY, USA
| | - Karim M Al-Azizi
- Department of Cardiology, Baylor Scott & White Health - The Heart HospitalPlano, TX, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele UniversityKeele, UK
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5
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Rahhal A, Provan D, Shunnar K, Najim M, Ahmed AO, Rozi W, Al-Khabori M, Marashi M, AlRasheed M, Osman H, Yassin M. Concurrent coronary artery disease and immune thrombocytopenia: a systematic review. Front Med (Lausanne) 2023; 10:1213275. [PMID: 37886354 PMCID: PMC10598342 DOI: 10.3389/fmed.2023.1213275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Coronary artery disease (CAD) management in the setting of immune thrombocytopenia (ITP) remains very challenging to clinicians as a reasonable balance between bleeding and thrombosis risks needs to be achieved, and the evidence guiding such management is scarce. Methods We conducted a systematic review following the PRISMA guidelines to summarize the available literature on the management and outcomes of CAD coexisting with ITP. We searched PubMed and Embase for studies published in English exploring CAD and ITP management until 05 October 2022. Two independent reviewers screened and assessed the articles for inclusion. Patients' characteristics, CAD treatment modalities, ITP treatment, and complications were reported. Results We identified 32 CAD cases, among which 18 cases were revascularized with percutaneous coronary intervention (PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and two cases were managed conservatively. More than 50% were men, with a mean age of 61 ± 13 years and a mean baseline platelet count of 52 ± 59 × 109/L. Irrespective of the revascularization modality, most patients were treated with either corticosteroids alone, intravenous immunoglobulins (IVIG) alone, or in combination. Among those who underwent PCI, two patients had bleeding events, and one patient died. Similarly, among those with CABG, one patient developed bleeding, and one patient died. Conclusion We found that revascularization with either PCI or CABG with the concurrent use of corticosteroids and/or IVIG for ITP was feasible, with an existing non-negligible risk of bleeding and mortality.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Drew Provan
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Khaled Shunnar
- Cardiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health—Unity Hospital, New York, NY, United States
| | - Ashraf Omer Ahmed
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Waail Rozi
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mahmoud Marashi
- Dubai Academic Health Corporation and Mediclinic Hospital, Dubai, United Arab Emirates
| | | | - Hani Osman
- Hematology and Oncology Department, Tawam Hospital, Abu-Dhabi, United Arab Emirates
| | - Mohamed Yassin
- Hematology Department, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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6
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Mostafa MR, Eid MM, Abuelazm M, Al-Abdouh A, Najim M, Hassan AR, El-Sakka AA, Renjithal SLM, Malik MA, Mohamed S, Balmer-Swain M, Paul TK, Goldsweig AM. Meta-Analysis of the Outcomes of Peri-Device Leak After Left Atrial Appendage Closure. Am J Cardiol 2023; 204:325-332. [PMID: 37572568 DOI: 10.1016/j.amjcard.2023.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I2 statistics to assess statistical heterogeneity; I2 >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I2 = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.
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Affiliation(s)
- Mostafa Reda Mostafa
- Department of Medicine, Rochester Regional Health, Unity Hospital, Rochester, New York
| | - Mohamed Magdi Eid
- Department of Medicine, Rochester Regional Health, Unity Hospital, Rochester, New York
| | - Mohamed Abuelazm
- Department of Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmad Al-Abdouh
- Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Mostafa Najim
- Department of Medicine, Rochester Regional Health, Unity Hospital, Rochester, New York
| | - Abdul Rhman Hassan
- Department of Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amro A El-Sakka
- Department of Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Muhammad Ahmed Malik
- Department of Medicine, Rochester Regional Health, Unity Hospital, Rochester, New York
| | - Sarah Mohamed
- Department of Medicine, Cairo University School of Medicine, Cairo, Egypt
| | - Mallory Balmer-Swain
- Department Cardiology, Rochester Regional Health, Unity Hospital, Rochester, New York
| | - Timir K Paul
- Department of Cardiovascular Medicine, University of Tennessee at Nashville, Ascension St. Thomas Hospital, Nashville, Tennessee
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts.
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7
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Mostafa MR, Najim M, Kusnik A, Sheikha MA, Magdi M, Fahmy MM, Shah S, Corteville DC. Syncope as the Sole Presentation of Multi-Vessel Coronary Artery Disease. J Community Hosp Intern Med Perspect 2023; 13:9-12. [PMID: 37868251 PMCID: PMC10589011 DOI: 10.55729/2000-9666.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 10/24/2023] Open
Abstract
Defining the etiology of syncope can be occasionally challenging. We present a case with no history of coronary artery disease (CAD) who presented exclusively with exertional syncope, and was found to have mildly reduced left ventricular systolic dysfunction on echocardiogram and severe multi-vessel CAD with chronic total occlusion (CTO) of the right coronary artery (RCA). Syncope as the initial presentation of advanced CAD in the absence of classic ischemic symptoms is rather an uncommon presentation in clinical practice.
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Affiliation(s)
- Mostafa R. Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, NY,
USA
| | - Mostafa Najim
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, NY,
USA
| | - Alexander Kusnik
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, NY,
USA
| | | | - Mohamed Magdi
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, NY,
USA
| | - Mostafa M. Fahmy
- Department of Medicine, Creighton University School of Medicine, Omaha, NE,
USA
| | - Sanjay Shah
- Department of Cardiology, Rochester Regional Health, Rochester, NY,
USA
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8
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Eid MM, Rivera LC, Mohamed S, Salar T, Mostafa MR, Najim M, Malik MA, Renjithal SLM. ORGANIZING PNEUMONIA: AN UNUSUAL SEQUELA OF COVID-19 INFECTION. Eur J Case Rep Intern Med 2023; 10:003787. [PMID: 36970163 PMCID: PMC10035623 DOI: 10.12890/2023_003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Organizing pneumonia (OP) is a form of interstitial lung disease that develops in response to acute lung injury. SARS-CoV-2 causes a wide range of lung and extrapulmonary disease, but there are few data suggesting an association between COVID-19 and OP. We describe a patient with COVID-19 pneumonia who developed severe progressive OP with significant morbidity.
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Affiliation(s)
| | | | | | - Tooba Salar
- Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | | | - Mostafa Najim
- Rochester Regional Health/Unity Hospital, Rochester, New York, USA
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9
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van Keulen S, Najim M, de Visscher JGAM. [Morsicatio related white lesions of the tongue borders and lower lip: a case report]. Ned Tijdschr Tandheelkd 2022; 129:553-555. [PMID: 36472308 DOI: 10.5177/ntvt.2022.12.22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A 28-year-old woman was referred by her dentist to an oral and maxillofacial surgeon for white lesions of the lower lip and lateral tongue borders on both sides. The diagnoss morsicatio labiorum and linguarum was made. Cheek, tongue, and lip biting occurs with some regularity and often patients are unaware of this habit. The diagnosis of morsicatio is based on clinical appearance and additional diagnostics are unnecessary. The condition belongs to a subcategory of obsessive-compulsive disorders. Treatment is not always necessary, but may consist of making the patient aware of the cause, possibly combined with symptomatic and/or causal therapy, for instance with an occlusal splint or cognitive behavioral therapy.
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Rahhal A, Najim M, Aljundi AH, Mahfouz A, Alyafei SM, Awaisu A, Habib MB, Obeidat I, Faisal MM, Alanzi MA, Nair AP, Elhassan A, Al-Dushain A, Abdelmajid AA, Abdelgader AE, Moursi AMA, Alharafsheh AEN, Kamar MRA, Goravey W, Omar AS, Abukhattab M, Khatib MY, Mohamedali MG, AlMaslamani MAR, Alemadi S. Adding colchicine to tocilizumab in hospitalized patients with severe COVID-19 pneumonia: An open-label randomized controlled trial. Medicine (Baltimore) 2022; 101:e30618. [PMID: 36181009 PMCID: PMC9524530 DOI: 10.1097/md.0000000000030843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Colchicine acts upstream in the cytokines cascade by inhibiting the nod-like receptor protein 3 (NLRP3) inflammasome while interleukin 6 (IL-6) receptor antagonists, such as tocilizumab, block the end result of the cytokines cascade. Hence, adding colchicine to tocilizumab with the aim of blocking the early and end products of the cytokines cascade, might reduce the risk of developing cytokine storm. METHODS AND ANALYSIS We aim to conduct an open-label randomized controlled trial to evaluate the efficacy and safety of adding colchicine to tocilizumab among patients with severe COVID-19 pneumonia to reduce the rate of invasive mechanical ventilation and mortality. We will include patients with severe COVID-19 pneumonia who received tocilizumab according to our local guidelines. Enrolled patients will be then randomized in 1:1 to colchicine versus no colchicine. Patients will be followed up for 30 days. The primary outcome is the rate of invasive mechanical ventilation and will be determined using Cox proportional hazard model. DISCUSSION Given colchicine's ease of use, low cost, good safety profile, and having different anti-inflammatory mechanism of action than other IL-6 blockade, colchicine might serve as a potential anti-inflammatory agent among patients with severe COVID-19 pneumonia. This study will provide valuable insights on the use of colchicine in severe COVID-19 when added to IL-6 antagonists. ETHICS AND DISSEMINATION The Medical Research Center and Institutional Review Board at Hamad Medical Corporation in Qatar approved the study protocol (MRC-01-21-299). Results of the analysis will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Alaa Rahhal, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar (e-mail: )
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health - Unity Hospital, NY, USA
| | | | - Ahmed Mahfouz
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Mhd, Baraa Habib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Obeidat
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Areeg Elhassan
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | | | - Wael Goravey
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Amr Salah Omar
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abukhattab
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Samar Alemadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
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Mahmoud M, Parambil J, Danjuma M, Abubeker I, Najim M, Ghazouani H, Al-Mohanadi D, Al-Mohammed A, Kartha A, Yassin MA. The Role of Primary Care Physicians and Reminder Systems in Increasing Colorectal Screening Recommendation [Response to Letter]. Adv Med Educ Pract 2021; 12:203-204. [PMID: 33688293 PMCID: PMC7935335 DOI: 10.2147/amep.s306373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Mohamed Mahmoud
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jessiya Parambil
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Abubeker
- Internal Medicine, Rochester Regional Health Unit, New York, NY, USA
| | - Mostafa Najim
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hafedh Ghazouani
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Dabia Al-Mohanadi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Al-Mohammed
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Anand Kartha
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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12
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Parambil JV, Najim M, Mahmoud M, Abubeker IY, Kartha A, Calaud F, Al-Mohamed A, Al-Mohannadi D, Chandra P, A Yassin M. Breast Cancer Screening Practices in a Tertiary Care Center in the State of Qatar: A Cross-Sectional Survey. Breast Cancer (Dove Med Press) 2021; 13:21-30. [PMID: 33447078 PMCID: PMC7802912 DOI: 10.2147/bctt.s285210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
Introduction Breast cancer is the most common cancer in females. In Qatar, mortality related to breast cancer came in third after lung cancer and leukemia. In this study, we aim to comprehensively evaluate the rate of internal medicine residents and faculty compliance with breast cancer screening in Hamad Medical Corporation (Doha, Qatar), as well as to identify barriers and facilitators that could potentially augment changes to enhance physician-led cancer screening. Methods A cross-sectional web-based survey was distributed among internal medicine physicians between December 2018 and March 2019 at a tertiary medical centre. It focused on the knowledge, attitude, and practice of physicians regarding breast cancer screening guidelines and explored potential barriers and proposed solutions. Chi-square and t-test statistics were used to draw conclusions where appropriate. Results A total of 158 physicians responded to the survey, with a response rate of 61%. 75.9% were postgraduate trainees. Around three-quarters of the physicians mentioned that they would recommend breast cancer screening for their age-appropriate average-risk patients. There was a statistically significant difference between the trainees, consultants, and specialists regarding the modality of choice, where the majority of the trainees opted mammogram every 2 or 3 years while 44.4% of the consultants indicated yearly self-breast exam (p<0.001). The percentage of survey participants who rarely to never offer breast cancer screening in the outpatient settings was 37.8%. Unclear pathway (40%) and lack of time in clinic/ward rounds (26.5%) were the major reported barriers for cancer screening. Conclusion In the current era of personalized medicine, physicians should be more oriented to local guidelines to provide optimal care to their patients. While the attitude towards breast cancer screening is positive, the overall compliance with the national recommendations is sub-optimal. Further initiatives and intervention programs are required to promote the breast cancer screening in Qatar.
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Affiliation(s)
| | - Mostafa Najim
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Mahmoud
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Anand Kartha
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Francois Calaud
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Al-Mohamed
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dabia Al-Mohannadi
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Mahmoud M, Parambil J, Danjuma M, Abubeker I, Najim M, Ghazouani H, Al-Mohanadi D, Al-Mohammed A, Kartha A, Yassin MA. Knowledge, Attitude and Practice of Physicians Regarding Screening of Colorectal Cancer in Qatar: A Cross-Sectional Survey. Adv Med Educ Pract 2020; 11:843-850. [PMID: 33192117 PMCID: PMC7657024 DOI: 10.2147/amep.s268315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The aim of this study was to evaluate the rate of internal medicine residents' and faculties' (specialists and consultants) compliance to colorectal cancer screening in Hamad Medical Corporation (Doha, Qatar) and to identify barriers as well as facilitators that will assist in drawing up changes that would enhance physician-related cancer screening. METHODS A cross-sectional web-based survey was distributed among internal medicine physicians at three component hospitals of Hamad Medical Corporation (HMC); focusing on knowledge and practice of colorectal cancer screening, its barriers and facilitators. Chi-square and t-test statistics were used to draw conclusions where appropriate. RESULTS The response rate for the survey was 91% and over 75% of the survey respondents were post-graduate trainees. The majority (90.6%) of the physicians (n=144) mentioned that they would recommend colorectal cancer screening for their asymptomatic patients, though trainees tend to choose the correct modality of screening compared to the consultants, 86.21% vs 40.74%. Only 43.4% of the survey participants always to usually recommend screening to their patients in their clinics while only 29.4% do so for their inpatients. Even though there was no statistically significant difference among the frequency of outpatient colorectal cancer screening among trainees, specialists or consultants (p=0.628), there was a clear increase in the reported referrals as the training years or the years of experience increases (p=0.049 for trainees and p=0.009 for faculty). Unclear pathway was reported as the main obstacle to outpatient cancer screening by 30.2% (n= 48) and 54% (n=87) pointed out that an easy and clear pathway for cancer screening would facilitate the same. CONCLUSION While the attitude towards colorectal cancer screening is positive, the actual practice of recommendation is sub-optimal. Further initiatives are required to facilitate awareness and compliance to colorectal cancer screening.
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Affiliation(s)
- Mohamed Mahmoud
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jessiya Parambil
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Mostafa Najim
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hafedh Ghazouani
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Dabia Al-Mohanadi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Al-Mohammed
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Anand Kartha
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Medical Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Thomas M, Raja M, Albakri M, Najim M, Chandra P, Allangawi M. CT score and correlation with lung function and microbiology of adult patients with cystic fibrosis with predominant I1234V genotype in Qatar. Qatar Med J 2020; 2020:4. [PMID: 32300549 PMCID: PMC7147265 DOI: 10.5339/qmj.2020.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Computed tomography (CT) features of cystic fibrosis (CF) lung disease can be objectively quantified using current CT scoring systems to assess the extent and severity of the disease. The aims of this study were to calculate the Santamaria CT scores in adult patients with CF with the predominant CFTR I1234V genotype, determine its reliability, and correlate these parameters with lung function, microbial colonization, compliance to treatment, and exacerbations. Methodology: This retrospective observational study was conducted on adult patients with CF who were regularly followed up in the adult CF service at Qatar via CT scans that were taken not during an acute exacerbation. CT scans were scored using the Santamaria scoring system. Corresponding spirometry, microbiological data of sputum culture, and relevant clinical data were correlated with individual CT scores. Results: Only 23 of the 31 patients underwent CT when not in an acute exacerbation and were included in the study analysis. A total of 20 (87%) patients had the I1234V genotype. There was good agreement between the two radiologists on the Santamaria CT scores with an intraclass correlation coefficient (ICC) value of 0.991. Bronchiectasis was the most consistent finding, followed by interlobular and intralobular septal thickening. Patients with poor lung function and frequent exacerbations had significantly higher CT scores (p = 0.015). The CT scores of patients colonized with Pseudomonas aeruginosa were higher but nonsignificant (p = 0.20). The mean CT scores were significantly higher in patients who were noncompliant to regular treatment than in those who were compliant (p = 0.012). Conclusion: Santamaria CT scores comprise a reliable scoring system for adult patients with CF and can be used to determine the extent and severity of lung disease. P. aeruginosa colonization causes more structural lung damage than other common colonizing organisms. Noncompliance to treatment has a significant impact on the increasing severity of CF lung disease.
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Affiliation(s)
| | | | - Mutaz Albakri
- Department of Chest, Hamad General Hospital, Doha, Qatar
| | - Mostafa Najim
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Prem Chandra
- Medical Research Centre Hamad Medical Corporation, Doha, Qatar
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Najim M, Smitha P, Agarwala V, Singh D. Development of Multi-Layer Zinc Oxide-Iron Composite Coatings for Microwave Absorption. ACTA ACUST UNITED AC 2014. [DOI: 10.1166/asl.2014.5549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Najim M, Serban I, Stitou Y, Turcu F. Multidimensional Schur coefficients and BIBO stability. Communications in Information and Systems 2005. [DOI: 10.4310/cis.2005.v5.n1.a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M. Najim
- ENSEIRB, Université Bordeaux 1, France
| | - I. Serban
- ENSEIRB, Université Bordeaux 1, France
| | - Y. Stitou
- ENSEIRB, Université Bordeaux 1, France
| | - F. Turcu
- ENSEIRB, Université Bordeaux 1, France
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Abid S, Fnaiech F, Najim M. A fast feedforward training algorithm using a modified form of the standard backpropagation algorithm. ACTA ACUST UNITED AC 2001; 12:424-30. [DOI: 10.1109/72.914537] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Youlal H, Janati-I M, Najim M. Two-dimensional joint process lattice for adaptive restoration of images. IEEE Trans Image Process 1992; 1:366-378. [PMID: 18296169 DOI: 10.1109/83.148609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The two dimensional (2D) joint process lattice (TDJPL) and its implementations for image restoration applications are examined. A 2D adaptive lattice algorithm (TDAL) is first developed. Convergence properties of the algorithm are covered for the 2D adaptive lattice least mean squares (TDAL-LMS) case. The complexity of the normalized algorithm is slightly more than that of the TDAL-LMS, but it is a faster-converging algorithm. Implementations of the proposed TDJPL estimator as a 2D adaptive lattice noise canceler and as a 2D adaptive lattice line enhancer are then considered. The performance of both schemes is evaluated using artificially degraded image data at different signal-to-noise ratios (SNRs). The results show that substantial noise reduction has been achieved, and the high improvement in the mean square error, even at very low input SNR, is ensured. The results obtained consistently demonstrate the efficacy of the proposed TDJPL implementations, and illustrate the success in its use for adaptive restoration of images.
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